Home births can yield low intervention rates without increasing problems for mothers and babies, according to a significant new U.S. midwifery study co-authored by a Bastyr University faculty member.
The study gathered data from more than 16,000 births attended by midwives. For women with low-risk pregnancies who were planning a home birth with a midwife, it found a 5.2 percent cesarean section rate, compared with the U.S. average of 31 percent for full-term pregnancies. The study is part of a decade-long project to help families and policymakers alike better understand birth care.
"Hospital maternity care tends to have a lot of intervention and technology in the labor process, so we don't have a lot of good data on what happens in births that unfold more naturally," says co-author Wendy Gordon, CPM, LM, MPH, a core faculty member in Bastyr's Department of Midwifery. "This project helps correct that."
The study was published in the peer-reviewed Journal of Midwifery & Women’s Health. Midwives throughout the country supplied data through the professional group Midwives Alliance of North America (MANA), reporting on births they attended from 2004-2009. The next round of analysis is already under way, with more than 900 midwives reporting on more than 1,000 births each month, Gordon says.
MANA hopes to influence a health care system that lags behind much of the developed world in birth outcomes, including cesarean rates, pre-term birth rates and mortality.
"Other countries do a better job integrating midwives into the health care system," says Gordon. "We want lawmakers and hospital leaders to know about this data."
A statement by Geradine Simkins, CNM, MSN, executive director of MANA, underscores the need to reconsider conventional approaches to birth: "When we consider the well-known health consequences of a cesarean — not to mention the exponentially higher costs — this study brings a fresh reminder of the benefits of midwife-led care outside of our overburdened hospital system."
Gordon said she was not surprised by the "amazingly" low cesarean rate or the rate of women with planned home-births who choose to transfer to hospitals (about 11 percent, usually for pain relief). Some of the outcomes for breech-position births were less encouraging (such as higher mortality rates), and Gordon says these findings, too, can help practitioners and expectant mothers make decisions.
"We have to talk about what these results mean in our profession," she says. "The goal isn't to claim that everything midwives do is perfect. If you're a mother who is carrying twins or has a baby in a breech position that doesn't want to move, this information can be helpful in considering the risks of various options."
Gordon has contributed to the MANA Stats Project since she began attending births 10 years ago. She has served on MANA's Division of Research developing reporting protocols and participating in quality assurance, calling midwives to ensure their medical records match the data they reported. (The study included both direct-entry midwives and nurse-midwives, in states with and without professional licensure for midwives.)
"I've been contributing data since I was a student, and I still contribute data from my practice," she says. "I believe in this project."
Learn more about studying midwifery at Bastyr.